Provider Demographics
NPI:1215344411
Name:ANNOR-MENSAH, KWAME (OTR/L)
Entity type:Individual
Prefix:MR
First Name:KWAME
Middle Name:
Last Name:ANNOR-MENSAH
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 27TH AVE
Mailing Address - Street 2:APT. 410
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-3905
Mailing Address - Country:US
Mailing Address - Phone:917-815-9023
Mailing Address - Fax:
Practice Address - Street 1:815 27TH AVE
Practice Address - Street 2:APT. 410
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-3905
Practice Address - Country:US
Practice Address - Phone:917-815-9023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-20
Last Update Date:2014-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0185041225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics